Doctor's choice of words can influence patient symptoms

Hezne Ezaty Abu Hasan, 18 May 2017

The words that doctors use can influence how patients perceive their pain or symptoms.

Good bedside manners are undoubtedly vital in patient care and complement the process of healing of the patient. However, not being careful with the choice of words to convey a message in doctor-patient communication, may just have the opposite effect and make the patient feel unwell.

A simple and casual mention of words like ‘hurt’ and ‘sting’ can make the patient feel pain or magnify the symptoms in conversations with the doctor.

‘Pain’, ‘vomit’, ‘panic’ on doctor’s unmentionable list

The power of suggestion is powerful enough to heighten patient’s worst fears with regards to their medical circumstance. Other words that are likely to have a negative impact include itch, worry, pain, vomit and panic.

Doctors are therefore advised to carefully choose words in relaying a message to patients and to refrain from using words that can have a negative impact, unless the patient uses them first. Dr Allan Cyna from Adelaide’s Women’s and Children’s Hospital suggests instead, to provide direct information about why something was being done to lessen patient’s negativity.

“The classic examples are ‘there is nothing to worry about’. If somebody who is perfectly calm is being told there is nothing to worry about, subconsciously you are implying there is something to worry about,” Cyna said.

When the usage is badly timed, such as before a procedure or surgery, it would likely impact negatively as doctors are auto-suggesting what the patient will feel and forewarning them.

Another example is ‘would you like to kiss your child goodbye’, and according to Cyna, “is a subconscious suggestion and often the parent will cry.”

Unhelpful words should be avoided

The “wrong” words are deemed so because they come to define all subsequent attempts at therapeutic interaction. In previous trials of patients having a drip inserted, those who were told it may ‘sting’ were more likely to voice their pain and become restless.

Another US study showed that replacing the phrase ‘there is a big bee sting coming’ when injecting anaesthetic into a patient with the phrase ‘we’re numbing the skin’ decreased the pain scores significantly.

Other experiments showed that warning patients of the side effects made it more likely for them to experience the nausea, fatigue, headaches and diarrhoea even if they were only on innocuous pills.

“People use this language with the best of intentions without realising they are inadvertently unhelpful,” said Dr Cyna. “The idea behind this is not to not say things, it is to say them in a therapeutic way, rather than an unhelpful way.”

Healing with words

On a different note, much like negativity, positivity can also be felt by patients and have the influence to affect the outcome. A study was carried out comparing acupuncture given by a highly positive practitioner and acupuncture given by a neutral practitioner.

The study noted that recipients of the highly positive practitioner experienced more relief regardless of correct or incorrect needle placement as compared to the recipients of the neutral practitioner even when the needles were correctly placed.

This holds similarity to the placebo effect; the healing power of good expectations, which is not the same to be said about its alternate, the nocebo effect.

The nocebo effect can be overcome by the placebo effect by taking an empathetic and caring attitude during diagnosis and emphasising the positive effects when prescribing medication, while making the negative side effects less intimidating by framing them and being careful not to over-emphasise the risks.

“I don’t think that’s going to be a burden for physicians or nurses. I think it’s going to be a way of making them feel a part of the treatment – that’s an awareness that’s just beginning in healthcare.” MIMS

At the recent Malaysian Community Pharmacy Business Forum (MyCPBF), a discussion forum was held on the subject of “Transcending Primary Healthcare Services: The Future of Specialized Pharmacy Services and Pharmacy Specialization”.